Why the NHS recommends Recovering Quality of Life (ReQoL-10) for use in Community Mental Health services

Patient Reported Outcome Measures (PROMs) are tools (usually in a questionnaire format) that help to assess an individual’s mental health and wellbeing needs and measure change. Measuring outcomes can help clinicians and services better understand the impact of 1:1 interventions; ensure services are meeting the needs of different service users; and monitor and improve effectiveness, efficiency and quality of the service offered to its service users.  It is important as it helps to understand the benefit and impact people receive from their mental health services.

In October 2021, NHS England and NHS Improvement established a task and finish group to look at a consistent approach to outcome measurement and recommend which PROMs should be used across CMH services for adults, including older adults, with severe mental illness. The group looked at a large number of PROMs and assessed against agreed selection criteria which included acceptability; validity; reliability; interoperability; and burden.

The group recommended the use of three PROMs, including Recovering Quality of Life (ReQoL-10).  ReQoL-10 was chosen because:

• It is recovery focused and can be used to assess the key recovery domains of connectedness, hope, identity, meaning and empowerment (CHIME) for people with different mental health conditions.  

• It was co-produced and tested with over 6,000 service users.  

• It provides an understanding of the factors contributing to service user’s own personal recovery 

• Nationally, it can be used to benchmark and build evidence and demonstrate good quality.  

The other PROMs recommended by the group were Goal Based Outcomes (GBO) and DIALOG. Each fulfils a different purpose and it is not expected that all three will be used at the same time and by the same care professional. The goal is for services to start embedding at least one of three PROMs in their systems in 22/23 with the aim of embedding all three in CMH services by the end of 23/24. Nationally, there will be an analysis of the data through the Mental Health Services Data Set (MHSDS) along with the development of supporting resources. 

The ReQoL-10 questionnaire has been developed into a visualisation tool which can now be accessed online https://reqol-visualisation-tool.group.shef.ac.uk/ Further resources can be accessed here: https://www.reqol.org.uk/p/overview.html 

One of the aims of the YH ARC Health Economics, Evaluation and Equality Theme has been to support NHS Trusts to meaningfully implement the data in the NHS to improve health outcomes for patients with mental health conditions through the implementation and use of the ReQoL. 

This blog was written by Dr Lizzie Taylor Buck and Amanda Lane, Health Economics, Evaluation and Equality theme, Yorkshire and Humber ARC.

ScHARR Mini Master Class in Health Research #13 - Supporting a mentally healthy NHS workforce - Dr Emily Wood - 14th July 1pm

Join us online for a monthly online masterclass by one of our health research experts based in The School of Health and Related Research

Supporting a mentally healthy NHS workforce - Dr Emily Wood

Book your place here

https://www.eventbrite.co.uk/e/supporting-a-mentally-healthy-nhs-workforce-dr-emily-wood-tickets-148269352625

Abstract:

There are over 100,000 vacancies in the NHS, meaning 1 in 12 jobs are unfilled. Half of staff report working unpaid overtime and 1 in 8 left the NHS in 2018. Chronic understaffing and long hours leads to significant stress with 40% of staff reporting suffering from work related stress in the NHS staff survey.

In 2015, NHS Professionals launched a large campaign to move NHS management thinking away from workforce wellbeing as a ‘nice to have’ and towards seeing it as a priority area. In 2020, NHS Employers launched ‘Get on-board with health and wellbeing priorities’, suggesting not much had changed in five years. Unfortunately this new initiative was launched in March and quickly got overshadowed by the COVID-19 crisis.

The pandemic shifted the focus of stress for the NHS workforce but it did not create it. Many were already struggling.

The majority of workforce wellbeing interventions focus on trying to help the staff member cope with stress. Many of these are short term interventions and do nothing to address the wider causes of stress in the first place. Some have even gone so far as to say these interventions are akin to victim blaming, as they suggest it is the worker’s fault they cannot cope with stress, when we should be looking at why they are under stress in the first place.

This webinar will look at some of the research we have done to model the complex relationships between staff retention, job satisfaction and wellbeing and organisational culture and place that in the wider context.

Bio:

Dr Wood is a mental health nurse researcher working in the School of Health and Related Research and the Health Sciences School at the University of Sheffield. Her research focuses on workforce issues, including staff experience, retention and wellbeing. She is currently working on two major projects, one on retention of mental health staff funded by the Health Foundation and one on workforce experience funded by the Royal College of Nursing.

https://www.sheffield.ac.uk/scharr/people/staff/emily-wood

https://twitter.com/emilyfwood

Join the live session by clicking the link below.

https://eu.bbcollab.com/guest/fbae374ad6ed4eeea1ed792b69cc2b6c

The live session takes place in a Collaborate webinar - headphones are advisable and easy to set up. You can join with a computer, tablet or smartphone, Chrome and Firefox offer the best browser experience. You can also use a phone to handle audio while in the session by dialling +44 2033 189610 and entering the PIN: 398 583 2702.

We look forward to seeing you online.

ScHARR Mini Master Class in Health Research #10 - The Factors associated with Student Mental Health - Reviewing the Evidence - Fiona Campbell and Elena Sheldon - 22nd April - 1-2pm (UK Time)

Join us online for a monthly online masterclass by one of our health research experts based in The School of Health and Related Research

The Factors associated with Student Mental Health - Reviewing the Evidence

Book your FREE place here

https://www.eventbrite.co.uk/e/the-factors-associated-with-student-mental-health-reviewing-the-evidence-tickets-137807198039

Abstract

Poor mental health of further and higher education students is a growing public policy concern. A 2020 Insight Network survey of students from 10 universities suggests that “1 in 5 students have a current mental health diagnosis” and that “almost half have experienced a serious psychological issue for which they felt they needed professional help” - an increase from 1 in 3 in the same survey conducted in 2018. The global coronavirus pandemic and measures to contain it has led to a worsening of the levels of poor mental health among young people including students in higher education. In order to develop high quality interventions that seek to improve the mental health of young people in higher education it is necessary to have a good understanding of the factors that contribute to poor mental health and also those that strengthen mental wellbeing.

Elena and Fiona have both led reviews in the past year that have looked at these factors. In this session, they will describe the different approaches they used to look at this problem and some of the methodological challenges that arose as a result. These include the challenges of measuring mental health outcomes, and synthesising different study designs to identify causal factors.

Despite using different approaches both reviews found consistent messages about the factors that increase the risk of poor mental health occurring in student populations, the factors that are protective of mental wellbeing and interventions that merit further development and evaluation. They look forward to describing their results in more depth, and highlighting areas where further research is needed.

Bios

Fiona Campbell

Fiona Campbell is a Research Fellow in Health Economics and Decision Science within the School for Health and Related Research (ScHARR) at the University of Sheffield. She has a clinical nursing background in oncology nursing, district nursing and health visiting and has worked in this capacity both in the UK and developing country settings. These experiences led to a keen interest in the use of research to inform and improve health care and public health. She trained in systematic review methodology and has conducted and published reviews for NICE, HTA and the Cochrane Collaboration. Her work has been used to inform NICE guidance for treatments for hypertension, obesity, excessive alcohol use, hospital errors and approaches to increasing levels of physical activity. She has designed, led and published work on methodological aspects of systematic reviewing and teaches systematic review methodology to postgraduate students.

https://www.sheffield.ac.uk/scharr/people/staff/fiona-campbell

https://twitter.com/fionabell19

Elena Sheldon

Elena joined the ScHARR Clinical Trials Research Unit in 2019 as a Research Assistant, having previously completed a BSc degree in Psychology at the University of Durham.

Elena is currently working on the MAGIC and ASTIClite studies. Prior to this, she worked as a Paediatric Research Assistant in the Clinical Research Facility at Sheffield Children’s Hospital and has worked as a Research Assistant in the Psychology Department at the University of Durham. In this role Elena examined 4D ultrasound scans of foetuses at various gestation, focusing on self-touch and facial expressions in relation to prenatal depression, stress and anxiety.

https://www.sheffield.ac.uk/scharr/people/staff/elena-m-sheldon

https://www.linkedin.com/in/elena-sheldon-9450a1126/?originalSubdomain=uk

ReQoL - Focus of UoS research feature

A team led by Professor John Brazier, together with colleagues from ScHARR – Dr Anju Keetharuth, Dr Jill Carlton, Dr Lizzie Taylor Buck and Janice Connell – and Professor Michael Barkham from the Department of Psychology, are the focus of one of the University's current research features, for their work with ReQoL.

For the full feature, please see link below.

https://www.sheffield.ac.uk/research/features/recovering-quality-life

Visit the ReQoL website

ReQoL - Patient Reported Outcome Measure

ReQoL

ReQoL is a new Patient Reported Outcome Measure, developed to assess the quality of life for people with different mental health conditions.  ReQoL was developed by the Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU) and the CLAHRC-YH, and was launched at the House of Parliament in October 2016. It places service users at the heart of their recovery and provides practitioners with a user friendly, valid and reliable measure to aid decision making and outcome monitoring.

Since the launch, many organisations have started using ReQoL-10 and ReQoL-20. Over 73 licences have been granted for a wide range of organisations including 23 mental health trusts which represents over a third of all the mental health trusts in England. We have produced a ReQoL case study highlighting implementation in one of the early implementer trusts.


To support national implementation, the ReQoL website has been updated and has links to a range of supporting materials including:

• A brief guide to help people interpret ReQoL score

• A short training presentation which can be adapted for specific trusts and cascaded through teams

• A co-produced information leaflet for service users

Also, translations of ReQoL are now available in Hindi and Kannada, and work is underway to translate ReQoL into other Indian languages. This work is being coordinated by Dr Nilamadhab Kar, Consultant Psychiatrist at Black Country Partnership NHS Foundation Trust and his team in India through Quality of Life Research and Development Foundation

New Projects: Efficiency, cost and quality of mental healthcare provision

ScHARR is working with the Universities of Birmingham and York on a research project that will use a quality of life framework to assess cost-effectiveness of mental health trusts and how they vary on cost and quality. It will assess organisational factors which drive improvements in cost and quality of mental healthcare and analyse how mental health trusts can reallocate resources in order to improve their efficiency and cost- effectiveness. The project is funded by the Health Foundation, an independent health care charity, as part of its £1.5 million Efficiency Research Programme. 

CC BY 2.0 Kevin Simmons http://bit.ly/2rBHr7V

Mental illness has a significant impact on individuals, society and the economy. The mental healthcare sector is under huge financial pressure and providers are undertaking large-scale cost reduction programmes. Service reconfigurations are impacting negatively on quality of care for patients and there is little understanding of how providers can reallocate resources to increase efficiency. This Efficiency Research project led by the University of York will look at the efficiency, cost and quality of current mental healthcare provision, and how changes can be made to drive efficiency improvements. The work package led by ScHARR will assess which quality indicators are valued by service users, clinicians, and the general population, for example improvements in outcomes, better and more equitable access to care, and distance to provider. We will derive QALY (quality-adjusted life year) weightings for these different aspects in order to assess efficiency, using a QALY framework. 

ScHARR will also estimate mapping functions that use HONOS data to predict utility values for Recovering Quality of Life (ReQoL), a Patient Reported Outcome Measure developed to assess the quality of life of people with different mental health conditions. The project team will then be able to produce a cost-effectiveness plane for mental health trusts to identify high-quality, low-cost providers and further examine organisational factors that are associated with cost-effectiveness. The project team hope to then estimate how resources can be reallocated to activities where they are more cost-effective, and what input-mix (e.g. capital, labour) might be associated with improved cost-effectiveness.

Health Foundation press release 

University of York press release


Further information about ReQoL